Preventing malaria and improving child survival in Madagascar

Angeline, 9, at home in Ankazomenavony, Madagascar with her insecticide-treated bed net, an effective means of malaria prevention.

By Misbah M. Sheikh and Diane Male

ANKAZOMENAVONY, Madagascar, 11 September 2006 – Angeline, 9, lives in this small village, home to just a few dozen families in northwestern Madagascar.

“Most of the time it is very hot here,” she says, “and there are lots of mosquitoes, many of whom are very bad because they give you malaria when they bite. I have had malaria. It is not nice.”

Malaria is endemic in northwestern Madagascar, as it is in other parts of this island nation. The disease is responsible for killing more children under the age of five than any other cause; out of the 60,000 child deaths every year in Madagascar, malaria accounts for nearly one third.

Shared benefits

Unlike diseases such as polio and measles, which can be prevented by a simple vaccination, malaria is carried by mosquitoes that are harder to eliminate. However, people can take precautions to decrease the chances of getting bitten by malaria-carrying mosquitoes.

“If you sleep under a bed net that has been treated by insecticides, this can help you keep away many of the bad mosquitoes that bite at night,” says Angeline.

“Not only that,” adds UNICEF Representative in Madagascar Barbara Bentein, “but evidence from the world over indicates that if enough people sleep under bed nets, those who are around them also benefit.” Pregnant women who use the nets tend to have healthier babies, for example, and bed net distribution offers opportunities to extend other public health benefits to children and families.

Collaboration with partners

This is why UNICEF is collaborating with the Malagasy Government and its partners to put in place a programme that not only addresses diseases such as malaria but also implements a series of integrated interventions to address child survival issues generally.

“We collaborate with our government and non-government partners to build latrines and water points for girls and boys in school,” adds Dr. Rabarijohn. “We train community and health workers on how to monitor the nutritional situation of children. And we work with ministries to improve the planning and monitoring of child survival programmes.”

Bed nets must be re-treated with insecticide every six months to remain effective at repelling malaria-carrying mosquitoes.

Positive signs in Brickaville

Brickaville is a town located close to the eastern shore of Madagascar, where UNICEF has been working since 1994 to promote child survival in association with local non-governmental organizations.

The results have been positive, with child-survival indicators in Brickaville registering higher than the national averages.

“Our methods are very simple,” explains the head of the Malagasy NGO Action Santé Organisation Secours, Jean Claude Rakotomalala. “We have basic exercises to help communities identify their problems. Communities cannot always find the funds or expertise they need, but this is where our partnership with UNICEF has been extremely fruitful.”

Long-term results

States Dr. Rabarijohn: “One cannot look at all the problems faced by children like Angeline in this country and address each one through a vertical program housed in the Ministry of Health. UNICEF’s approach is to deal with these issues in an integrated manner, just as a family would do.”

It is an approach that focuses on long-term results for children.

For her part, Angeline is looking to the future. “When I grow up, I would like to be a doctor or a teacher,” she says. “That way I can either help to keep children healthy or teach them ways to stay healthy.”